Timing of ventriculoperitoneal shunt insertion following spina bifida closure in Kenya.

PURPOSE: In Western medical centers, emphasis has been placed on simultaneous myelomeningocele closure and ventriculoperitoneal shunting for children with spina bifida (SB) and co-morbid hydrocephalus (HC). This is not practical in developing countries where patients present in a delayed fashion, many with open, dirty myelomeningoceles. The purpose of this study was to evaluate whether timing of shunting in relation to myelomeningocele closure affected shunt-related complications such as SB wound infection, shunt infection, and shunt malfunction.

METHODS: A retrospective analysis was undertaken of all SB patients undergoing ventriculoperitoneal shunting within 11 days following myelomeningocele closure at Kijabe Hospital between 1997 and August 2007. Data were collected from hospital records and analyzed in SPSS.

RESULTS: Over the study period there were 276 patients included. Eighteen patients were shunted prior to SB closure and 13 patients had simultaneous shunting and SB closure. Patients shunted prior to, simultaneously, or within the first 4 days after SB closure had a fivefold higher shunt infection rate (23%) than those shunted 5-10 days following SB closure (4.7%) (p < 0.0001). Shunt malfunctions were also significantly higher in the group shunted prior to back closure (33.3%) vs. those shunted simultaneously (15.4%) or within the first 10 days following SB closure (13.9%) (p = 0.0001). No difference was seen in these groups with regard to wound infections. No difference in shunt-related complications was observed between those shunted 5 to 10 days following back closure.

CONCLUSIONS: This study indicates that in developing countries, patients with SB who present in a delayed fashion but require shunting and have sterile CSF, should have their shunts inserted 5-10 days after SB closure.